Nancy Cruzan's Legacy Touches Us All

December 28, 1990|by ELLEN GOODMAN The Boston Globe Newspaper Co.

Death did not come gently to Nancy Cruzan.

It took almost eight years from the car accident that left her unconscious to the death certificate. It took almost three years from the time her parents asked to end treatment to the time a Missouri court agreed. It took 12 days from the moment the feeding tube was removed to the moment she stopped breathing.

The last week in the life of the young woman whose body was locked in a fetal position and whose mind was permanently obliterated was not easy either. Pickets appeared on the hospital lawn. Protesters forced their way onto her floor. Reporters stood death watch, sending out updates on the deteriorating condition.

Joe and Joyce Cruzan, for their part, spent days in their daughter's room and nights in the mobile home set up on the hospital lawn. But in the end, they wrested from the state and from modern medicine, the terrible right to bury their child.

Her death did not come gently to any of the Cruzans.

I will spare the family any message about the larger good in their loss. They have been through enough. I can only imagine how this ordeal prolonged and distorted their mourning. There is no upbeat, sunny side for the family.

But for those of us who knew not Nancy Cruzan but the inanimate Cruzan Case, there is an extraordinary legacy. The Cruzan case, like that of Karen Ann Quinlan, became a story that made America talk publicly and at length about death in the technological age.

In the press, the case was often cast as the right to die versus the right to life. In the courtroom, especially the Supreme Court, it was about the right of families versus the right of the state.

But in the everyday language of Americans talking to each other, Nancy Cruzan's terrible fate made spouses as well as lawyers, friends as well as legislators, talk about the quality of life and the quality of mercy. We were forced to confront the paradox that the same technology that can save us can also doom us to what Nancy's own doctor called "a living hell."

As Daniel Callahan, the director of the Hastings Center, said in a sort of eulogy, "There is the balance of Greek tragedy here. We want the very advances that have given us this problem."

For much of human history, the medicine man or woman was also the caretaker. Medical mercy meant helping people, and helping people often meant helping them to die peacefully.

But in our lifetime, medicine improved in its ability to save life and doctors redefined kindness as a cure. Death became a technological failure. As Callahan says, "The National Heart and Lung Institute is not set up to allow us to die more peaceably from heart disease but to cure it."

Our gratitude to science, our own passionate pursuit of medical salvation, now comes with increasing unease about this same technology. We fear that there may be too much of a good thing. That we can't stop it.

This is what Nancy Cruzan came to represent as she lay twisted, bloated, unconscious, in her hospital bed. As people came to feed her what the hospital ludicrously called "supper." As the doctors described her condition as a "persistent vegetative state." As others argued -- is this better? -- that they had seen tears in her eyes.

She came to represent the unintended consequences of technology, the side effects of our best intentions, the cruelty of our modern medical mercy. She came to represent something worse than death.

In time, people may wonder why Americans spent so much time arguing about sustaining one unconscious woman while so many others in our society died for lack of medical care. They may wonder, how on the brink of deliberate killing of thousands -- in war -- we paid so much attention to the quality of one life.

But every family that has been prompted to talk aloud about life and death, every hospital that has been forced to think about aggressive treatment, every medical school that has been prodded to teach young doctors about dying, has a piece of Nancy Cruzan's legacy.